CZ38110U1 - An aiming device for the meniscus root repair - Google Patents

Description

In the registration procedure, the Industrial Property Office does not determine whether the subject of the utility model meets the conditions of eligibility for protection according to § 1 of Act. No. 478/1992 Coll.

Meniscus root repair target

Field of technology

The technical solution refers to the aimer, which makes it possible to drill precisely localized channels to perform the two-channel technique of refixation of the detached root of the posterior corner of the medial or lateral meniscus.

Current state of the art

Targets are used in orthopedics to accurately target planned bone canals and play a key role in the precise placement of fixation elements during meniscal root refixation. These specialized instruments help the surgeon to precisely determine the location and set the correct angle of the bone canals for the insertion of fixation materials such as anchors or fibers. There are different types of sights that differ according to the specific fixation technique and the type of fixation material used.

The known state of the art is, for example, the solution described in document EP 2548522 B1, where the aimer includes a support structure, an arm ending in a point and one guide with a cavity for guiding the drill bit. The design of this aimer allows the aimer to be attached to the bone with a tip and a single guide, i.e. only two contact points, which allows for a large amount of unwanted movement of the aimer during surgery, and thus the tool must be held at all times. Furthermore, the locking mechanism of the disclosed tool does not allow simple control, for example with one hand.

Current aimer solutions do not allow simple drilling of bone canals during meniscal root surgery without excessive manipulation during surgery and constant holding by the operator. Current solutions also do not allow good visibility or directly obstruct the view of the operated area. It is therefore desirable to develop an aimer that could be easily and fully connected to the bone, so that the operator would have his hands free for other activities during the operation, while at the same time allowing good visibility of the attachment of the aimer tip and the mouth of the drilled canals.

The essence of the technical solution

The above-mentioned deficiencies are eliminated by the aimer for meniscal root repair according to the technical solution. This aimer includes a support structure, an arm, a first guide, and a second guide, wherein the arm is attached to the support structure at one end thereof, and at its other end, the arm includes a hook tipped with a spike, the support structure includes a first opening through which the first guide passes, and a second opening , which is further from the shoulder than the first opening and through which the second conduit passes, the first conduit and the second conduit having a cylindrical shape and including a cavity extending through the entire length of the conduit, the support structure including a first locking mechanism for locking the first conduit and a second locking mechanism for locking second management. The longitudinal axis of the first guide and the longitudinal axis of the second guide belong to the same plane, are oriented centrally towards the tip and their intersection lies in the given plane behind the tip in the direction from the supporting structure.

The aimer for meniscal root repair according to the presented technical solution is indicated for use in meniscal root repair to accurately target the planned bone canals for performing the two-channel technique of refixing the detached root of the posterior corner of the medial or lateral meniscus.

The specific design of the presented aimer allows fixation on the bone in 3 different places: the tip and two guides, while this three-point fixation ensures a firm fixation on the bone without the need to hold the instrument in any way, and thus the operator has more space for other actions during the operation. Among the main advantages of the aimer according to the presented technical solution is also its creation precisely

- 1 CZ 38110 U1 of localized bone canals during meniscal root repair. Accurate localization of the canals will ensure repair in an anatomical position, which is a necessary condition for minimizing the risk of failure. The ease of use shortens the operative time and the small diameter of the drilled canals reduces the invasiveness of the procedure, which reduces the risk of mechanical or infectious complications.

A target is a tool used to precisely aim other tools, especially drills, to create clearly defined structures during surgery.

Thanks to the arrangement of the first and second guides described above, the mouths of the drilled bone canals are also far enough apart and leave enough bone structure between them. The structural stability of the bone at the site of the canals is thus only minimally disturbed.

This is precisely achieved by the fact that the intersections of the longitudinal axes of the first and second lines lie as far behind the tip in the direction of the supporting structure, since the tip is caught in the area of the outlet of the drilled channels. The aimer presented herewith ensures the creation of channels so that their geometry respects the bone architecture and the maximum strength of fixation of the knee structures is achieved within the performed operation. The aimer allows the operation to be performed without implants or other auxiliary structures, as the preserved bone structure provides sufficient means to hold the fibers during the operation.

Advantageously, the first guide includes at least 3 notches along its outer wall and the second guide includes at least 3 notches along its outer wall, wherein the first locking mechanism includes a resiliently mounted latch oriented toward the longitudinal axis of the first guide and the second locking mechanism includes a resiliently mounted latch oriented toward the longitudinal axis of the second line. Preferably, the second guide includes a greater number of notches than the first guide. This method of arresting ensures a firm attachment of the aimer to the bone while at the same time simple operation.

Preferably, the first guide and the second guide at their end closer to the tip include teeth along at least part of the circumference of the mouth of the cavity passing through the entire length of the guide. Thanks to the teeth, the guides are even more firmly attached to the bone.

The axis of the first guide and the second guide form an angle of 2 to 20°, preferably 2 to 10°, more preferably 3 to 5°.

Clarification of drawings

The essence of the technical solution is further clarified on implementation examples, which are described using the attached drawings, where on:

Fig. 1 is a target for meniscus root repair according to the first exemplary embodiment with drills inserted into the first and second guides in a three-dimensional view, Fig. 2 is a target for meniscus root repair according to the first exemplary embodiment with drills inserted into the first and second guides shown in profile, Fig. 3 is the aimer for meniscal root repair according to the first exemplary embodiment with drills inserted into the first and second guides shown from below, Fig. 4 shows the first and second guides according to the first exemplary embodiment, Fig. 5 is the aimer for meniscal root repair according to the first exemplary embodiment embodiment with the longitudinal axes of the first and second guides depicted in a three-dimensional view, Fig. 6 is a targeter for meniscal root repair according to the first exemplary embodiment hooked in the insertion site during surgery, Fig. 7 is a targeter for meniscal root repair according to the first exemplary embodiment hooked in the insertion site and held by the first and second guides during the operation and the drill shown.

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Examples of implementing a technical solution

The technical solution will be further explained on examples of implementation with reference to the relevant drawings.

The target for repairing the meniscus root according to the first exemplary embodiment of the technical solution is shown in Fig. 1 to 7, while it includes a support structure 1, an arm 2, a first guide 3 and a second guide 4. The arm 2 is firmly attached at one end to the support structure 1 and at its other end, the arm 2 includes a hook 5 terminated by a point 6, the support structure 1 comprising a first opening through which the first guide 3 passes, and a second opening located further from the arm 2 than the first opening and through which the second guide 4 passes, the first the guide 3 and the second guide 4 have a cylindrical shape and include a cavity passing through the entire length of the guide 3, 4, while the support structure 1 includes a first arresting mechanism for arresting the first guide 3 and a second arresting mechanism for arresting the second guide 4.

The first guide 3 is slidably movable in the direction of the longitudinal axis 7 of the first guide and rotatably movable around the longitudinal axis 7 of the first guide and stored in the first opening. The second guide 4 is slidably movable in the direction of the longitudinal axis 8 of the second guide and rotatably movable around the longitudinal axis 8 of the second guide is mounted in the second opening.

The longitudinal axis 7 of the first guide, the longitudinal axis 8 of the second guide and the tip 6 belong to the same plane, they are oriented centrally towards the tip 6 and their intersection lies in the given plane behind the tip 6 in the direction from the supporting structure 1, as can be seen in Fig. 3. The longitudinal axes 7, 8 of the first and second guides make an angle of 4° together and point approximately towards the tip 6. In Fig. 1, 2, 3 and 5 it can be seen that the longitudinal axis 7 of the first guide runs almost immediately next to the tip 6 and the longitudinal axis 8 of the second guide is further offset from the tip 6 behind the longitudinal axis 7 of the first guide.

The first guide 3 includes 50 notches 9 along its outer wall and the second guide 4 includes 80 notches 9 along its outer wall, viz. Fig. 4. These sets of notches 9 can also be referred to as ratchets. The notches 9 are oriented perpendicular to the longitudinal axis 7, 8 of the given line and are distributed along the same length of the line 3, 4 for both lines 3, 4, so in the case of the second line 4, the notches 9 have a greater density (it has more notches 9 per unit length) . Notches 9 are located only on one side of the guide 3, 4, while the other sides of the guide 3, 4 across the longitudinal axis 7, 8 of the given guide are smooth without notches 9. The notches 9 gradually connect at their ends to the smooth second wall of the guide 3, 4 so , to ensure a smooth transition of the latch from the notches 9 to the smooth wall of the guide 3, 4 when turning the guide 3, 4.

The first locking mechanism includes a resiliently mounted latch located in the region of the first opening oriented toward the notches 9 of the first guide, and the second locking mechanism includes a resiliently mounted latch located in the region of the second opening oriented toward the notches 9 of the second guide. The latches cannot be seen in the attached drawings, they are located inside the support structure 1 and pass through the wall of the first and second openings in the support structure 1, where they rest on the passing lines 3, 4.

The first guide 3 and the second guide 4 at their end closer to the tip 6 include teeth 10 forming teeth around the entire circumference of the mouth of the cavity passing through the entire length of the guide 3, 4. At their opposite end, the guide 3, 4 includes a plate-shaped handle.

The construction of the aimer according to the first exemplary embodiment is made of stainless steel.

In alternative exemplary embodiments of the technical solution, the arresting mechanisms can be made, for example, as tightening threads for tightening around the guide 3, 4 and its arresting, or a screw resting on the given guide 3, 4 in the place of the opening in the supporting structure 1. However, such solutions are difficult to handle , as they are structurally more complex and/or cannot be locked and released with one hand.

- 3 CZ 38110 U1

In an alternative embodiment, the guides include fewer notches 9, the location of which is calculated to arrest the given guides 3, 4 in the required location relative to the bone. More notches 9, however, allow the sight to be attached in many more ways, while it is not necessary to accurately calculate the location of the notches 9. In another exemplary embodiment, each line can thus have 3 notches 9, 10 notches 9, 20 notches 9 or, for example, even 50 notches 9. Preferably, that the second line 4 has more notches 9, or has a greater density of notches 9 (has more notches 9 per unit length), while more preferably the first line 3 has 30 notches and the second line has 10 more notches 9, in another embodiment the first line 3 has 60 of notches 9 and the second guide 4 with 30 more notches 9. Likewise, the guides 3, 4 can also have a larger number of notches 9 than the above-mentioned number of notches 9, thus enabling an even more precise and firm fit without exerting too much pressure on the bone.

The operative procedure for meniscal root repair using the aimer according to the first exemplary embodiment will be described here.

The patient is operated in the standard position for knee arthroscopy, i.e. lying on his back with the thigh fixed in a holder. The knee is flexed to 90° and hangs freely over the edge of the folded table. During the operation, the knee can be positioned in extension. Surgery is performed through standard anteromedial and anterolateral ports. For good access to the posterior corner, it is important to place the anteromedial port as low as possible above the anterior corner of the medial meniscus and as closely parapatellar as possible. In rare cases, a posteromedial port may need to be created to suture the meniscus. For manipulation of the posterior horn, it may sometimes be appropriate to create an accessory anteromedial or anterolateral port.

A condition for success in the diagnosis and therapy of a root lesion is to ensure a good view and access to the area of the posterior horn. Surgery on the medial meniscus cannot be safely performed without releasing the posteromedial compartment (MCL release). This procedure is best performed with a pink 18G needle inserted percutaneously just behind the posterior border of the medial collateral ligament, just above the superior border of the meniscus. In this area, the posterior oblique ligament (POL) is weakened by several diagonally upward injections, and the gradual opening of the internal joint space is observed while levering into valgus.

After verification of the tear, the mobility of the meniscus is verified. If the tear is of an older date and the meniscus is already beginning to extrude, it is often necessary to sharply release the posterior corner from the adhesions with the posterior capsule.

Subsequently, we locate the anatomical position of the advertising site (footprint). The medial meniscus attaches to the tibia about 10 mm behind the medial intercondylar eminence. The correct position is always behind the back edge of the tibia, on the diagonally downward converging surface on the dorsal side of the tibia, and the insertion site must not be visible when viewing the knee from the front with a standard arthroscope. The meniscus must be refixed to a well-cleaned bone bed for healing. The insertion site must be carefully removed from the back corner of the meniscus with the help of a curved spoon, shaver and vaper, and the bone decorticated.

If the bone bed is prepared and the posterior corner of the meniscus can be reattached to it without tension, the posterior corner of the meniscus is sutured using one of the preferred techniques. The meniscus is sutured with simple sutures introduced vertically 5 to 10 mm from the posterior corner in a place where the tissue is already stronger, closer to the base of the meniscus. Alternatively, other meniscal suturing techniques can be used according to the operator's preference (e.g. so-called Luggage-Tag or horizontal mattress suture). It is advisable to use threads of different colors, ideally knitted threads of strength #2. The technique can be used antegrade (e.g. FirstPass Mini, Knee Scorpion, etc.) or exceptionally retrograde through the posteromedial port using suturing needles (Suture Shuttle). All 4 fiber ends emerging from the posterior corner of the meniscus through the anteromedial port are secured by the pean.

The aimer according to the first exemplary embodiment of the technical solution is subsequently introduced in front of the anteromedial port, see Fig. 6. By slightly tilting the aimer to the longitudinal axis of the tibia, smooth insertion of the arm 2 with the tip 6 into the rear compartment is ensured. We position the target so that the longitudinal axis of the support structure 1 forms an angle of 20 to 40° with the longitudinal axis of the tibia. The exact value of this angle depends

- 4 CZ 38110 U1 on anatomical conditions and on the position of the anteromedial port. The tip 6 is aimed at the front edge of the insertion site and, with a slight pull, is stuck into the bone. The first guide 3 and the second guide 4 are inserted through a 1.5 cm mini-incision to the bone and gradually pushed in - first the first guide 3 (cranial drill sleeve), then the second guide 4 (caudal drill sleeve). The latches of the arresting mechanisms in cooperation with the notches 9 of the respective guide 3, 4 ensure a firm arrest of the aimer on the bone. The greater density of the notches 9 on the second guide 4 then ensures that the teeth 10 of the first and second guides 3, 4 fit precisely to the bone, resulting in a connection with the bone that is not loose and does not, on the contrary, exert excessive pressure on the bone.

In the next phase, under arthroscopic control, two channels are drilled with a K-wire or a 2 mm drill, see Fig. 7. The intra-articular outlet of the channels is at the edges of the insertion site. The cranial channel leads to the front edge and the caudal channel to the rear edge, the junction of both channels is perpendicular to the longitudinal axis of the rear corner of the meniscus. This position of the channels ensures maximum coverage of the advertising space.

Through the cavities of the first guide 3 and the second guide 4, stretching loops are introduced into both channels so deep that their tips can be seen in the joint. For example, any monofilament nylon with a strength of USP 1 and a length of at least 70 cm folded in half so that it forms a loop (so-called loop) can be used. Alternatively, a thin binding wire or wire loop (eg Chia Percpasser, Wire Loop, etc.) can be used. By rotating the first and second guides 3, 4 around the respective longitudinal axis 7, 8, the notches 9 are released from the latch of the locking mechanisms and thus the fixed connection of the aimer to the bone. The first and second guides 3, 4 are then pushed out of the support structure 1 and then the rest of the sight is removed. If the extension loops are pulled into the channels when handling the sight, they can be reinserted deeper to expose their tips in the knee. They are then pulled out through the anteromedial port. Fibers that are dorsal to the meniscus are threaded into a caudal loop that passes through the posterior canal, and by pulling the loop, these fibers are pulled through the posterior canal. Fibers that are ventral to the meniscus are then threaded into a cranial loop that passes through the anterior canal, and by pulling the loop, these fibers are pulled through the anterior canal. After that, the knee is extended and flexed several times while simultaneously pulling on all the fibers so that the meniscus fits well into the bed.

The fibers can be knotted in two ways, through an implant or without the use of an implant through a bone bridge. When knotting through the implant, ideally a button with four holes is used, while the corresponding ends of the fibers from the cranial and caudal canal are knotted together. The knob is positioned on the connector between the channels. When tightening the sutures, it is advisable to arthroscopically check the compression of the root of the meniscus into the bed. When knotting without the use of an implant, a pair of fibers from the caudal canal form the so-called post. Slip stitch cannot be used. To the stretched pair of fibers from the caudal canal (the so-called post), we knot the fibers from the cranial canal with individual knots (e.g. Revo knot). It is advisable to use a knot pusher to tighten the stitches. When tightening the knots, it is advisable to arthroscopically check the compression of the meniscus root into the bone bed. After knotting the fibers, the root of the meniscus is firmly repaired. With good mobilization of the meniscus, correct insertion of the fibers and good position of the canals, we achieve maximum coverage of the insertion site and the root repair is anatomical.

Industrial applicability

The target according to the presented technical solution can also be used for other orthopedic operations, especially when clamping torn muscle tissue.

Claims (4)

1. A target for meniscal root repair comprising a support structure (1), an arm (2), a first guide (3) and a second guide (4), wherein the arm (2) is attached at one end to the support structure (1) and on its at the other end, the arm (2) includes a hook (5) tipped with a point (6), wherein the support structure (1) includes a first opening through which the first guide (3) passes, and a second opening located further from the arm (2) than the first opening and through which the second guide (4) passes, the first guide (3) and the second guide (4) having a cylindrical shape and including a cavity passing through the given guide (3,4) along its entire length, while the support structure (1) includes a first locking a mechanism for arresting the first guide (3) and a second arresting mechanism for arresting the second guide (4), characterized in that the longitudinal axis (7) of the first guide and the longitudinal axis (8) of the second guide belong to the same plane, are oriented centrally, and their intersection lies in the given plane behind the tip (6) in the direction from the supporting structure (1). 2. Target for meniscal root repair according to claim 1, characterized in that the first guide (3) includes at least 3 notches (9) along its outer wall and the second guide (4) includes at least 3 notches (9) along its outer wall, wherein the first locking mechanism includes a resiliently mounted latch oriented toward the longitudinal axis (7) of the first guide for locking the first guide (3) and the second locking mechanism includes a resiliently mounted latch oriented toward the longitudinal axis (8) of the second guide for locking the second guide (4) . 3. Target for meniscal root repair according to claim 2, characterized in that the second guide (4) includes a greater number of notches (9) than the first guide (3). 4. Target for meniscal root repair according to claims 1 to 3, characterized in that the first guide (3) and the second guide (4) at their end closer to the tip (6) include teeth (10) along at least part of the circumference of the mouth of the cavity passing through the entire by the length of the given line (3,4).